This present invention relates to an improvement in oral therapy, and more particularly to a comprehensive and dynamic approach to oral therapy addressing Temporomandibular Disorders [TMD], Temporomandibular Joint Disorders [TMJ], headaches, parafunctional behavior of the mandibular complex, and their inter-relationship with one another.
Headache is a multifactorial disorder which is a recurring, disabling event affecting a very functional and largely compliant population. Numerous articles, professional and lay, propounding various treatment options have been written through the years. These include medication management strategies both abortive and prophylactic, suffering-based management strategies and their reduction such as biofeedback and relaxation training, non-drug therapy including acupuncture, muscle therapies including both avoidance agents and specific paralyzing agents.
Experience and studies of the headache phenomenon and the various aspects of treatment have shown headache disorders to be slowly progressive with many individuals reporting initial infrequent headache events that, over time, increase in frequency, intensity, and duration. This is often associated with increasing medication use and has been identified as a specific subcategory termed analgesic rebound. It is also known that this rebound phenomenon is not limited to analgesic agents but has been discerned in the presence of many other agents.
It has been found that treatment of headache with a soft dental splint is an effective non-invasive therapy for migraine and tension vascular headaches [Lucia, “Modern Gnathological Concepts—Updated” (Quintessence Publishing Co., Inc., Chicago, 1983), page 64]. In one study, 39 of 53 headache patients who had been diagnosed and referred for treatment by a neurologist reported a marked improvement in their headache symptoms after treatment with a soft occlusal splint for night wear or extended wear and 18 of 22 of patients with migraine or vascular tension headaches reported an improvement [Id., at page 64]. What follows is a brief description of several types of oral splints which also may serve as an ancillary to a headache regimen and, more importantly, to a comprehensive oral-therapy strategy.
Typically, localized occlusal interference splints [LOIS] for the mouth are appliances suited for persons who habitually clench their teeth or who are bruxists [clinical symptoms of Temporomandibular Disorders (TMD)]. These splints function by overloading the periodontal receptors of two teeth in an arch thereby reflexly reducing the muscle force generated by the person experiencing TMD. The main function of this type of splint is as a ‘habit breaker.’ It is best to wear this type of splint at night though it may be worn at any time when the person is aware of a parafunctional disorder or habit. The splints can be worn for short periods of time on an as-needed basis [Id., at page 39].
A similar type of splint is an occlusal splint which also is a removable appliance which fits over the occlusal and incisal surfaces of the teeth in one arch creating precise occlusal contact with the teeth of the opposing arch. It is commonly referred to as a bite guard, night guard, interocclusal appliance, or orthopedic device. This type of splint typically can be used [1] to provide a more stable or functional joint position; [2] to introduce an optimum occlusal condition which reorganizes the neuromuscular reflex activity; or [3] to protect the teeth and supportive structures from abnormal forces which may create breakdown or tooth wear or both. [Okeson, “Fundamentals of Occlusion and Temporomandibular Disroders” (The C. V. Mosby Company, St. Louis, 1985), page 333] Splint therapy has also been used for treatment of Temporomandibular Disorders [TMD]. Protuberances of approximately 4 mm in width have also been placed at the anterior arches of the occlusal surfaces of such splints to act as anterior stops for the splint. [Id., at page 337] Such stops are generally flat and perpendicular to the long axis of the contacting mandibular incisor and should extend to where a mandibular anterior central incisor will contact [Id., at page 340].
Temporomandibular Joint Disorders [TMJ] can cause headaches, jaw clenching, and bruxism [side-to-side grinding of teeth]. Some headaches are related to problems with the temporal mandibular joint. It has been shown that a mouth-bite splint can be fashioned to prevent a person from clenching and realizing the various symptoms of TMJ and, in particular, soft bite guards which better absorb occlusal forces by virtue of their soft nature and aid in TMD and TMJ therapy [Lucia, “Modern Gnathological Concepts—Updated” (Quintessence Publishing Co., Inc., Chicago, 1983), page 38].
The Shore Mandibular Autorepositioning Appliance [SMAA] is another appliance which can aid in TMJ and TMD therapy. It was developed in approximately 1960. The SMAA frees the mandible from malocclusion and transmits the force of mandibular closure through the teeth to the maxilla thus removing pressures from the traumatized joints. In making the SMAA, a temporarily incorrect functional occlusion is created in acrylic. An acrylic-plate cast is made for the upper teeth, fitted to the person's teeth. An acrylic ramp [protuberance] approximately 3 mm thick is fabricated on the lingual aspect of the central incisors [similar to that discussed above with a 4 mm anterior stop [protuberance]; Shore refers to the anti-occluder [protuberance] as a “ramp”]. The acrylic plate cover the palatal surface and the ramp acts as the splint [anti-occluder]. The ramp must be such that there is a clearance between the upper and lower posterior teeth to thereby prevent their respective occlusion [Shore, “Temporomandibular Joint Dysfunction and Occlusal Equilibration” (J.L. Lippincott Company, Philadelphia, Second Ed., 1976), pages 238–241].
Over the past 10 years, there have been a number of other specific and unique, if not unconventional, new treatments proposed for headaches, and research and treatment innovations continue. As interest grows and more people suffer or become more acutely aware, solutions and treatments are sought and, thereby, continue to evolve. No one to date has considered a comprehensive approach which encompasses and addresses the mandibular complex as it relates to various mandibular disorders and headaches.
Recently specific muscle agents, such as botulinum toxin, are being discussed and utilized. Use of such muscle agents for treatment of headaches is extremely expensive and, notwithstanding, currently is on the rise. This care plan is associated with reduction of headache frequency and, although expensive, enjoys some cost-efficacy due to a reduction in office visits, reduction in visits to urgent-care facilities, and a reduction in one's medication regimen and its associated costs. Unfortunately, botulinum toxin's duration of action is limited to three to four months and often requires repeat and continued care. There is also significant injector-variability making outcomes inconsistent. Total volumes and locations have also been largely variable making some literature question this care. Mild complications have begun to arise, including volumetric loss of muscle in frequently repeated injection sites.
In spite of this growing interest and concern, what remains missing from the equation is the comprehensive approach and strategy taking into account the various causes and effects, direct and indirect, associated with headache, TMD, and TMJ. A more dynamic approach and strategy is needed for directive and cost-effective therapy plans. This is notable in both drug and non-drug therapy plans.
Prior to any headache treatment strategy or any comprehensive oral-therapy regimen for that matter, clear goals of care must be assessed and discussed which include headache frequency reduction, extent [if any] of TMJ or TMD, an exercise regimen, elimination of urgent care and emergency department utilization, and positive impacts on intensity and duration.
The system envisioned by the present invention fills the void in the prior art and is designed to be included in existing treatment plans for headaches, TMD, TMJ, and other parafunctional behaviors of the mandibular complex, to reduce or eliminate the muscle component present in all such disorders. For headaches, its availability may be included in both migrainous and non-migrainous headache populations and available to all levels of frequency. Use of the system envisioned by the present invention would have a positive impact and reduce the need for additional care or frequency of such care and costs associated with such care by professional care givers.
The foregoing has outlined some of the more pertinent objects of the present invention. These objects should be construed to be merely illustrative of some of the more prominent features and applications of the intended invention. Many other beneficial results can be attained by applying the disclosed invention in a different manner or by modifying the invention within the scope of the disclosure. Accordingly, other objects and a fuller understanding of the invention may be had by referring to the summary of the invention and the detailed description of the preferred embodiment in addition to the scope of the invention defined by the claims taken in conjunction with the accompanying drawings.